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Lots of questions! Hope its not overwhelming!!!

I have a 4 week old that was born 5 weeks early. Breast feeding was very important to me but while in the hospital I learned I had slightly inverted nipples and with her being slightly premature, she wasn't able to latch well. I have been using a shield but I would really like to wean my baby from the shield (mostly for convenience while in public)... Any suggestions? **I have attempted to remove the shield periodically and she can latch but she seems to get frustrated so I have to put the shield back on so she can continue to eat.

I'm currently feeding her every 3 hours, alternating sides. I'm pumping the opposite side every time I feed her. I am going back to work in a month and I am concerned about pumping at work. My job requires me to be on my feet and working with patients from the time I walk in at 7:30 am until I leave, without any real "breaks". I'm concerned that I will not be able to pump every three hours, will this mess up my supply if I can't pump on time daily?

Lastly (and thank you for your patience), If I am out and about without the baby, and she uses a bottle (so I miss a feeding), do I pump when I get home or do I wait until she gets hungry next time? I just want to make sure my supply doesn't get messed up. I would like to BF as long as possible!

Thanks everyone in advance for any answers/suggestions you have to offer! I just want to do whats best for her!!

Re: Lots of questions! Hope its not overwhelming!!!

Hello, mama. First of all, you are doing an awesome job remaining committed to breastfeeding!

I can't speak as to the inverted nipples or weaning from a shield, but you might check kellymom.com for some good articles. I'm sure other LLL ladies will have some experiences to share with you as well. For now, just be glad that the shield has helped you bf thus far. Continuing bfing is most important.

In terms of feeding: every 3 hrs might be too long. Is she cueing every 3 hrs, or do you feed by schedule? When my LO was that age (and he was full term), I was feeding him every 1-3 hrs, with an average of 2 hrs in between feedings, so that he consistently ate 7-8 times per day. I believe the recommendation is 8-12 times. If I were you, I would try to work in more nursing sessions, especially with a premie. Also, I could get my LO to nurse from both sides, usually about 20 min on one and 10-15 on the other. Is there any reason you are only feeding on one side and pumping the other? For some babies this works well, for others like mine they will take both sides if offered. I think constant offering is the key to getting LO to nurse more.

As to the pumping: I believe the recommendation for pumping if you are away 8 hrs is 3x/day, something like 1.5 oz for every hour you are away from baby. That said, you will need to pump at work, a minimum of 2x but should be at 3x, if you want to supply breastmilk for her bottles and not formula. You should definitely check your state's laws concerning breastfeeding. Most states require that employers provide you: 1. breaks to pump, and 2. a clean, private place to do so. Especially today, there are many laws and breastfeeding advocates that protect a mom's right to pump while at work.

If you are going out and are going to be away from baby, I would try to pump sometime. If it's only occassionally, missing a feeding won't really impact your supply. I've gone out to dinner and skipped a feeding while grandma gives baby a bottle. But if it's more frequently, or you will feel engorged, then do pump. Before or after, whatever makes more sense in your situation. If you've just fed her right before leaving, then wait to pump when you get home. Or if you will need to feed her when you get home, pump a few oz right after feeding her while the breast are "primed" for it. Another alternative--if you know you will need to be away from baby later in the day and will nurse her right before and after returning, you could add a pumping session in the morning, usually after the first of the morning feed, when you have the most milk. That way, you are saving milk to use for later and are not really "losing" a feeding, if that makes sense.

But key to maintaining supply is pumping at work. You will have to do this in order to keep up with baby's milk requirements and avoid formula.

Re: Lots of questions! Hope its not overwhelming!!!

Hi mama, welcome to the forum! And feel free to ask as many questions as you have!

1) Weaning from nipple shield: this is best done with the help of a lactation consultant, preferably and IBCLC (International Board Certified Lactation Consultant). Have you been working with a LC? She can help evaluate baby's latch without the shield, provide helpful suggestions if it's still problematic etc. A good latch is the foundation of successful breastfeeding so really important to get it right.

2) Feeding every 3 hours: Are you doing this on a schedule? Although there are ideas out there about scheduled feedings, exclusive breastfeeding works best if you ditch the schedule, follow baby's cues, and feed on demand. At times this may be every hour, or you may do what feels like a continuous long feeding over a couple hours (cluster feeding), most often in the evening hours. Then there may be other times that baby will take a 3-4 hour nap. As long as baby is getting in enough feedings - 10-12 would be normal for a newborn, but minimum 8 - is having enough wet and poopy diapers, and gaining weight appropriately, you know you're on the right track.

3) Pumping at work: it is absolutely essential that you have time to pump at work. Otherwise your supply will go down. You don't say how long you are at work for, but typically a 9 hours separation (for example) would mandate 3 pumping breaks at a minimum - usually every 2.5-3 hours. Can you talk to your supervisor before going back to work about how you can fit in your pumping sessions? You'll probably need at least 20 minutes per session, maybe longer. The pumping breaks do not have to be at exactly the same time each day but they should be spread out throughout the day. Ways to use your precious break time: don't bother with washing pump parts - you can put them in a bag in the fridge, or even leave them at room temperature; have a cooler to stick your milk into, etc. If your supervisor is stingy with break time - do you have any charting you need to do? One option is to get a hands-free setup (you can by a camisole/pumping bra, or make one yourself by taking a snug-fitting cami and cutting holes in it) so that you can pump while charting. Some moms feel stressed by trying to work and pump at the same time, and make pumping "relax" time, whereas for others, feeling like they're getting behind in what they need to get done is more stressful, and they like to work and pump. You'll have to see how you feel and also adjust to the reality of your work situation.

4) Out and about: the best thing is to learn how to nurse in public. There's a specific forum on this, you might want to browse through there to get ideas on what to wear to provide the best coverage, and just to get your courage up! Most people feel a little nervous about this at the beginning but it gets better with practice. I understand the shield is part of your reluctance right now, hopefully you can get weaned off of that and that will help. But if you do give the baby a bottle, then yes, it's best to pump to replace the missed feeding. I mean, an occasional outing is not a big deal but if you are regularly giving baby a bottle that should be replaced with pumping.

Re: Lots of questions! Hope its not overwhelming!!!

Hey there! The previous posters have already answered a lot of your questions, so I'll share my experience with weaning from the nipple shield. First, you mentioned that your LO was born 5 weeks early and is now 4 weeks old, it's still before the due date, so baby may not be mature enough to latch without the help of the nipple shield just yet. My LO was born at 38 weeks and I really noticed a difference in maturity when he hit his due date. I found it really helpful to start with either the nursing shield or pumping to pull out my nipple so it was easier for him to latch on. You may have to play and see which works better for you. I found a manual pump easier to use for this than pulling out and setting up the electric. Try using the "nipple sandwich" technique to make the nipple and areola easier for baby to latch onto. Expect baby to be somewhat fussy, because this is new, different, and more difficult! If baby gets really fussy, you can switch back to the nipple shield or offer your finger (nail side down towards the tongue so you don't damage baby's soft palate) for baby to suck on to calm down and reorganize their senses before trying again. Definitely go see the lactation consultant if you can.
Good luck!

DS "milk monster" 2/7/13
Abscess didn't stop us nursing!
DH 6/26/10 is the best support

Re: Lots of questions! Hope its not overwhelming!!!

I was told in the hospital that I should feed her every three hours and to establish a schedule so that I didn't become a pacifier. I was also told it takes 2 hours for your breasts to replinish the milk that she had recently finished. With that being said I do feed her if she is hungry. I had been feeding her from both sides for 15 minutes but she started to not take the second side, I then just let her stay on one side and then I'd pump the other. I do really want to get her to go on both sides to reduce the need to pump so I've been trying to switch her after 10 minutes.

I'm realizing that feeding on demand is the way to go but is there reason for being concerned if she doesn't "empty" my breasts every time? Should I pump to make sure? She does seem to be getting much more efficient with nursing, what used to take 30 minutes now takes 20 and she seems to be happy for the same length of time. Giving me reason to believe she's getting enough.

Thanks so much for the recommendations for getting rid of the shield. She has a great latch according to the lactation consultant so its just a matter of her not getting frustrated.

Re: Lots of questions! Hope its not overwhelming!!!

Oh my goodness, what terrible advice from the hospital!!!

First, it is absolutely untrue that it takes 2 hours for your milk to replenish. I have absolutely no idea where that idea comes from. Sounds like something someone read on the side of a can of formula. Anyway, milk is ALWAYS being made. The emptier the breast is, the faster milk is being made to replace what has been removed. A breast that has just been emptied very thoroughly by a baby or a pump will still deliver milk to a nursing baby, albeit a little slower than a breast that is really full. A baby who is nursing on an "empty" breast will get a meal, provided she nurses long enough.

Second, schedules are the enemy of breastfeeding success. Supply is created by demand, and when you restrict demand by spacing the baby's feedings out to some artificial interval, supply goes down. So what if you "become the baby's pacifier"? Breasts were invented before pacifiers, and breasts are designed to serve the dual purpose of providing nutrition AND comfort. And if you don't simply trust the baby to nurse at the right level, you're always stuck worrying that the baby hasn't emptied the breast enough, and instead of simply enjoying nursing your baby you are stuck pumping. Why is that better?

Once you are nursing on demand and not using a shield, you can stop worrying so much about emptying yourself and just do what most nursing moms do: watch the baby's diaper output, overall health and happiness, and weight gain. If those three metrics remain normal, then you can just trust the baby to keep your breasts as empty as they need to be.

Re: Lots of questions! Hope its not overwhelming!!!

I also am a new mom and Bf is very important to me as well, my lil man is about to be 2 months and I still havent got the hang of it but me and him together are getting through. I also was told about a schedual being very important but realized that it just made it more difficult cause if something came in between the schedual it through us both off, so I said nope and now i listen to my body and my baby sometimes he does just want to pacify and sometimes he only will eat for 5 to 10 minutes but he is happy and healthy so I figure I must be doing something right . My most trouble with Bf was the worry and stress but I am a little more relaxed now mainly from this website, it has answered questions and concerns and also offered support .So good for you for keeping it up.

Re: Lots of questions! Hope its not overwhelming!!!

Wow who keeps telling mothers to schedule? This is out and out wrong and destructive advice. At worst, scheduling (drawing out time between nursing sessions) has been shown to lead to low production and failure to thrive, at best, it REALLY overcomplicates breastfeeding.

It's important that a newborn nurses very frequently- AT LEAST 10-12 times a 24 hour day for the first 6 weeks or so. More often is normal and fine. IN some cases, during the first 1 or 2 weeks some babies need to be awoken in order to nurse often enough. But this good frequency will usually simply happen on it's own as long as mamma feeds baby when baby cues as well as whenever mom wants to. Cluster feeding and pacifying at the breast are normal and vital parts of the breastfeeding process. This are not only ok, it is needed in most cases to ensure breastfeeding gets off to a good start and keeps going well. ...you cannot offer to nurse too much!

As far as emptying the breast, this is also misleading advice, because the body is always making milk, and breasts come with different storage capacities. So "emptying" for one mom is a different story than for another. As long as baby is gaining well and mother is feeling that her breast is less full or 'softer' after a nursing session all is probably fine.

It is fine to let baby nurse on one side per session, if that is what baby wants. But it is ok to offer the other breast as well if mom is feeling very full. But there is certainly no need to switch after 10 minutes or any other set time. (EDIT: Switch nursing-switching breasts one or several times per session- is a technique to build production-so in a case that a mom has low production, then it can be useful.) Generally we suggest "let baby finish the first breast" and then switch if baby wants. We also say “Watch your baby, not the clock.”

ngarcia, you are pumping after nursing due to supply concerns because you are using a nipple shield...correct? Who gave you the shield and is this their instruction? It has long been thought that pumping after nursing was needed whenever any mom uses a shield but the thinking now (as shield design is much improved) is that some mothers do and others do not, and some moms are fine just pumping some of the time or as needed. It depends on several things, including WHY the shield is being used and how well baby is able to extract milk when nursing with the shield.

Re: Lots of questions! Hope its not overwhelming!!!

They told you that at the hospital??!! Oh my goodness!! What terrible advise!! I am so glad you found this forum!! You will definatley get more insight and correct information by sharing and learning from the ladies on this forum..I know I have!!

Happy Mama of 4 beautiful boys ages 17, 13, 10, 3 and just welcomed the newest member of the family on 3/22/2016 OUR FIRST GIRL!! :
Was not able to BF first 3 boys but now successfully and thriving

Re: Lots of questions! Hope its not overwhelming!!!

Hi mama, so to answer your question on when to nurse--offer to nurse asap as soon as you come home. Never mind if he has just eaten or not. You can ask that the caretaker not feed within an hour of pickup time. Every time your LO latches on it sends a signal to your body to make more milk. That is how to correct low supply. SO offer, offer, offer.

You might consider sleeping safely in close proximity to your LO when you go back to work to accommodate night nursing. Your break schedule is going to temporarily lower your daytime milk supply to safeguard you from getting clogged ducts and mastitis. So this is a good and natural process to lower milk supply in response to less frequent nursing. Take a look into moving the crib into your room so you can night nurse more easily. I co-sleep safely. My DH was sceptical at first but he loves, loves, loves it.

Katharine in BelgiumBe the change you want to see in the world--Mahatma Gandhi
DD2 Feb 2015 - natural birth VBAC with DD (2010) & DS (2011 VBAC)
Ouch! Is it thrush or Raynaud's phenomenon?